Did The New York Times ‘get it wrong’ about Tinnitus?

by Daniel Fink, MD, Chair, The Quiet Coalition

Photo credit: Marcus Aurelius

Did The New York Times “get it wrong” about tinnitus? I think it might have. In an “Ask Well” feature from April, the Times states that tinnitus is “a common and usually harmless condition.” I don’t think that’s correct.

Tinnitus is ringing in the ears, technically the perception of sound without an external source.  There are many potential causes of tinnitus. The exact mechanism of how tinnitus develops has not yet been definitively determined, but current theories point to a rewiring of brain circuits. Aside from the serious causes of tinnitus requiring additional diagnostic testing, e.g., tinnitus caused by a tumor, the overwhelming percentage of tinnitus cases are caused by noise exposure. One expert estimated that 90% of people with tinnitus also have hearing loss. The Times article calls tinnitus “a harmless byproduct of hearing loss.”

That’s where I think the Times and the experts it cites get it wrong. My assessment of the literature is that tinnitus, even temporary ringing in the ears after a loud noise exposure, indicates that permanent auditory damage has occurred. The damage may not be to the cochlear hair cells, the sensory organs for hearing, but to the nerve connections — the synaptic junctions — between the hair cells and the auditory nerve.

Perhaps most ominously, having tinnitus has been linked to an increased risk of developing dementia. Whether this is an independent association or whether the causal factor is hearing loss associated with tinnitus has not been elucidated. The correlation between hearing loss and dementia is so strong that research is being done to determine if providing hearing aids to older people with hearing loss can delay or prevent the onset of dementia. That doesn’t sound “harmless” to me.

As the Times notes, there are no cures for tinnitus. There is only one FDA-approved treatment for tinnitus, the Lenire device. From talking with people with tinnitus and from my own experience, symptoms usually improve over time. The best way to help this recovery along is to studiously avoid exposure to loud noise. 

Understanding the dangers of noise means knowing what safe noise exposure levels are. The only evidence-based safe noise exposure level for the public was calculated by the Environmental Protection Agency in 1974: 70 decibels time-weighted average for a day. The actual safe noise exposure level may be quite a bit lower, 55 A-weighted** decibels for a single noise event and a daily average of 55-60 decibels. Impulse noise, or sudden short bursts of noise, may have a disproportionate impact on hearing.

My advice to those who have tinnitus, and to those who don’t want to develop it, is that if something sounds loud, it’s too loud and one’s auditory health is at risk. Turn down the volume, leave the noisy environment or use hearing protection and one should be protected from both hearing loss and tinnitus.

*This article may be behind a paywall. We try to avoid writing about article behind a paywall, but the Times has a very large circulation and is an important news source so we are making an exception.

**A-weighting adjusts unweighted sound measurements to approximate the frequencies heard in human speech.

DISCLOSURE: I served on the board of the American Tinnitus Association from 2015-2018. My noise interests are in prevention of noise-induced auditory disorders, not in the treatment of any of them, including tinnitus.